Objective
Great toe reconstruction, especially in the distal phalanx level which requires relatively thin and pliable skin envelope and bone stalk support is a challenging work in both functional or aesthetic consideration. With the sophisticated microscopic skills, SCIP flap was introduced in recent years and its chimeric use for reconstruction has gained a lot of popularity. In this article, we presented our experience of chimeric SCIP osteocutaneous flap for amputated great toe reconstruction and its aesthetic outcome.

Materials and Methods
An 18-y/o male, who was involved in a motorcycle accident and right foot degloving injury with great toe distal phalanx nearly total amputation were noted at ER presentation. After initial management, gangrene change was still noted over the right great toe unfortunately. A chimeric SCIP osteocutaneous flap consisting of a 2.5cm bone stalk and two skin paddles(12x4cm2 and 8x4cm2 ) was harvested for right big toe reconstruction. The bony segment was fixed by two wire loops, and the extensor hallucis longus and flexor hallucis longus were sutured at proximal phalanx. Primary wound closure could be accomplished in the donor site region with acceptable tension.

Results
No significant complications occurred in the postoperative course and the flap survived completely. At the end of one month after the operation, partial weight bearing on the patient’s right foot was resumed and the rehabilitation program was arranged subsequently. At the end of two months, the patient could wear footwear and required no assistance during ambulation. Secondary debulking surgery for excessive skin flap and one granuloma were performed two months after the reconstruction. Satisfactory aesthetic and functional outcomes could be achieved.

Conclusions
Soft tissue and bony defects of the great toe are usually seen after trauma and remain a reconstruction difficulty. Chimeric SCIP osteocutaneous flap, which provides pliable skin and vascularized bone stalk might be a resolution for the great toe reconstruction.

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